Diagnostic Accuracy of Transvaginal Ultrasound for Detecting Endometrial Polyps in Women with Abnormal Uterine Bleeding: A Cross-Sectional Study
Keywords:
Abnormal uterine bleeding, Endometrial polyps, Transvaginal ultrasound, Histopathology, Diagnostic accuracyAbstract
Background: Abnormal uterine bleeding (AUB) is a widespread gynecological complaint with endometrial polyps as an underlying cause. Although hysteroscopy with histopathology is a resource-intensive and invasive diagnostic tool, it is also the gold standard. Transvaginal ultrasonography (TVS) is a noninvasive option, but its diagnostic accuracy is not consistent
Objective: To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in detecting endometrial polyps in women with AUB, using histopathology as the reference standard.
Methods: This cross-sectional study was conducted on 150 women aged 18 to 45 years with AUB in the Department of Diagnostic Radiology, Lahore General Hospital/PGMI, Pakistan, who underwent TVS and then hysteroscopic histopathology. The diagnostic parameters of TVS sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Subgroup analysis was conducted according to menopausal status.
Results: TVS had a sensitivity of 69.2, specificity of 53.2, PPV of 23.7, NPV of 89.2%, and total accuracy of 56.0. False positives were primarily proliferative or secretory endometrium, focal hyperplasia, and submucosal fibroids, while false negatives were mainly small sessile polyps or due to poor imaging. There was no significant difference in the diagnostic performance between premenopausal and perimenopausal women. The polyp was benign in most cases, and no malignant or atypical lesions were detected.
Conclusion: TVS is moderately sensitive and has a high NPV; therefore, it is a good noninvasive method for excluding endometrial polyps in women with AUB. Positive results must be validated by histopathology. Color Doppler and timing optimization of imaging can be used to improve the diagnostic quality. TVS is also affordable, available, and easy to use in resource-restricted environments.
